title: The RBANS Effort Index: base rates in geriatric samples.
abstract: The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.
authors.affiliation: Center for Alzheimer's Care, Imaging and Research, Department of Neurology, University of Utah, Salt Lake City, Utah 84108, USA. kevin.duff@hsc.utah.edu
authors.forename: Kevin
authors.initials: K
authors.lastname: Duff
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Spering
authors.forename: Sid E
authors.initials: SE
authors.lastname: O'Bryant
authors.forename: Leigh J
authors.initials: LJ
authors.lastname: Beglinger
authors.forename: David J
authors.initials: DJ
authors.lastname: Moser
authors.forename: John D
authors.initials: JD
authors.lastname: Bayless
authors.forename: Kennith R
authors.initials: KR
authors.lastname: Culp
authors.forename: James W
authors.initials: JW
authors.lastname: Mold
authors.forename: Russell L
authors.initials: RL
authors.lastname: Adams
authors.forename: James G
authors.initials: JG
authors.lastname: Scott
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D012016:Reference Values